Congenital GI Conditions

Question 1

What maternal medication use may cause pyloric stenosis?

Answer 1

Erythromycin

Question 2

What type of emesis will be present with pyloric stenosis?

Answer 2

NON-bilious, although projectile

Question 3

List the main findings with pyloric stenosis

Answer 3

• Non-bilious vomiting after each feed
• Olive shaped mass in epigastric region
• Visible peristaltic waves

Question 4

Olive shaped mass and visible peristaltic waves are seen with what condition?

Answer 4

Pyloric Stenosis

Question 5

What imaging modality should be done with pyloric stenosis?

Answer 5

US

Question 6

What metabolic derangement will be present with pyloric stenosis?

Answer 6

Metabolic Alkalosis
LOW K+ and Cl-

Question 7

What is the treatment for pyloric stenosis?

Answer 7

NPO
Hydration/electrolyte correction
Pyloromyotomy

Question 8

What is intussusception and where does it usually occur?

Answer 8

Portion of bowel telescopes into an adjacent portion
- often at ileocecal valve

Question 9

What is the triad of symptoms with Intussusception?

Answer 9

1. Episodic abdominal pain
2. Vomiting
3. Bloody “currant jelly” stool

Question 10

What is the triad of symptoms with Intussusception?

Answer 10

1. Episodic abdominal pain
2. Vomiting
3. Bloody “currant jelly” stool

Question 11

What type of mass may be felt with Intussusception?

Answer 11

Sausage shaped in the RUQ with an empty RLQ

Question 12

What will an US show with Intussusception?

Answer 12

Bullseye

Question 13

What is the best diagnostic/treatment for Intussusception?

Answer 13

Air enema

Question 14

Malrotation with volvulus involves what?

Answer 14

Bowel twists on itself causing an obstruction

Question 15

What symptoms will be present with Malrotation/Volvulus?

Answer 15

Bilious emesis
Abdominal distention
Bloody stool

Question 16

What symptoms will be present with Malrotation/Volvulus?

Answer 16

Bilious emesis
Abdominal distention
Bloody stool

Question 17

What causes a Meckel Diverticulum?

Answer 17

Failure of the vitelline duct to obliterate which causes a true diverticulum

Question 18

What type of ectopic tissue is the in the Meckel Diveritculum?

Answer 18

Gastric and Pancreatic tissues

Question 19

What is the main sign of Meckel Diverticulum?

Answer 19

PainLESS blood in the stool

Question 20

Painless blood in the stool is concerning for?

Answer 20

Meckel Diverticulum

Question 21

Rule of 2’s with Meckel Diverticulum

Answer 21

2 types of tissue
2x more common in boys
2 years of life is common presentation
2 inches long
Within 2 feet of ileocecal valve

Question 22

What test is diagnostic for Meckel Diverticulum? What does it detect?

Answer 22

Meckel Scintigraphy scan (tech 99m) detects gastric tissue

Question 23

What causes Hirschsprung disease?

Answer 23

Lack of ganglion cells to migrate to the distal colon

Question 24

When ganglion cells do not migrate to the distal colon, what occurs there?

Answer 24

Unopposed contraction, with no relaxation and no peristalsis

Question 25

What is often the first sign of Hirschsprung Diisease?

Answer 25

Failure to pass meconium

Question 26

With a rectal exam, what 2 findings are often seen with Hirschsprung Disease?

Answer 26

- NO stool in the rectal vault - Expulsion of stool after rectal exam

Question 27

If Hirschsprung disease is mild, how may it present in older kids?

Answer 27

Chronic constipation

Question 28

What will be seen on XR with Hirschsprung Disease?

Answer 28

Distended proximal bowel with paucity (absent) of air in rectum

Question 29

What will a Barium Enema show with Hirschsprung Disease?

Answer 29

Dilated proximal colon Narrow distal colon

Question 30

What is the most definitive test for Hirschsprung disease?

Answer 30

Rectal biopsy

Question 31

What will a rectal biopsy show with Hirschsprung Disease?

Answer 31

Absent myenteric and submucosal plexuses

Question 32

A portion of the bowel undergoes necrosis with Necrotizing Enterocolitis. What are 2 risk factors?

Answer 32

Premature birth Formula feeders

Question 33

In the first few days/weeks of life, what will present with Necrotizing Enterocolitis?

Answer 33

Feeding intolerance Abdominal distention Bloody stool

Question 34

In the first few days/weeks of life, what will present with Necrotizing Enterocolitis?

Answer 34

Feeding intolerance Abdominal distention Bloody stool

Question 35

What is diagnostic on XR for Necrotizing Enterocolitis?

Answer 35

Pneumatosis Intestinalis = Air bubbles in the bowel wall

Question 36

If you see air in the bowel wall, what should you suspect?

Answer 36

Necrotizing Enterocolitis

Question 37

If Necrotizing Enterocolitis is more severe, what else can you see on XR?

Answer 37

Air under the diaphragm (perf.) Air in portal venous system

Question 38

What is the treatment for necrotizing enterocolitis?

Answer 38

NPO, IV antibiotics and surgery